PB2219: A REAL-WORLD EXPERIENCE WITH HEALTHCARE RESOURCE UTILIZATION PATTERNS AND RELATED COSTS IN PATIENTS WITH SICKLE CELL DISEASE IN NORTH LEBANON
Authors: A. Inati, M. Sabbagh, C. Al Alam, A. Al Kheir, Z. Massouh, R. Demachkie, C. Ojaimy, N. Dani, A. Siddiqui, R. Rajat Adhikary, B. Lynch, A. Srivastava
Journal: HemaSphere (2022)

Background: Sickle cell disease (SCD) remains associated with high healthcare resource utilization (HRU), despite a reduction in morbidity and mortality associated with the use of disease-modifying therapies, mostly because of vaso-occlusive crises (VOC). In Lebanon, there are limited national estimates on HRU, cost of medical care, and treatment expenditures for patients with SCD. A better understanding of these estimates may provide new perspectives to improve access to high-quality cost-effective health care services. Aims: Aim of our study is to evaluate patterns of HRU and related cost in a cohort of patients with SCD receiving care in a Comprehensive SCD referral center at NINI hospital in North Lebanon. Methods: An observational, non-interventional, retrospective study of 136 patients (54.4% females) with confirmed diagnosis of SCD was conducted in North Lebanon. Data on HRU, including ED visits, ambulatory visits, and hospitalizations, was collected in a patient health information (PHI)-anonymized format from patients’ paper and electronic medical files, as well as hospital and ED files, from May 1, 2018 to April 30, 2020. Uncomplicated VOCs were defined as pain crises, whereas complicated VOCs were defined as acute chest syndrome, acute splenic sequestration, acute hepatic sequestration or priapism. The annual rate of HRU visits was calculated as a ratio of the total number of visits to the total number of years of follow-up across all patients. Based on the available data, the average yearly cost was determined as the ratio of the total cost of these visits to the total number of years of follow-up. Results: The median age of patients in this study was 10.8 years (IQR 5.3 to 19.6 years) at the time of investigation. Majority of patients were diagnosed with SS (72.1%) and Sβ0 (21.3%) genotype across all age groups. The most prevalent SCD-related complications were pain crisis (90.4%), fever (43.4%), acute chest syndrome (33.1%), and acute splenic sequestration (22.8%). Most of hospitalizations, ICU visits, and ED visits in adult patients (age >16 years) were due to uncomplicated VOCs. The average annual costs of HRU were 8,270,920 Lebanese pounds (LBP) amounting to 5,514 USD (per patient per year) of which 92.1% was for hospitalizations, 4% for ED visits and 3.9% for ambulatory visits. Uncomplicated VOCs had the highest annual costs for ED, ICU and hospitalizations. Costs related to medications, diagnostics, non-hematologist medical consults, uncompensated care and lost productivity are not included in this analysis. Analgesics, folic acid and hydroxyurea were the most commonly prescribed drugs across all age categories, with hydroxyurea being prescribed to 84% of patients. Image:Summary/Conclusion: SCD and associated complications resulted in significant acute HRU, according to this real world study. VOCs continues to be most important factor for resource use, ICU admission and costs, with hospitalizations accounting for majority of annual costs. Despite the high HRU rate in this relatively young SCD cohort, the cost of HRU in a comprehensive setting with effective outpatient management as that in North Lebanon appears affordable for the health care system. However when additional SCD related and non SCD related costs of care are factored in, the economic burden of SCD care is likely to be far higher than the figures presented here.